Medicare Fraud is a Serious Problem that Needs Your Action – Blow the Whistle to Earn Potential Cash

Medicare fraud occurs when someone knowingly deceives the government healthcare program to receive payments when they should not, or to receive a higher payment than they should.

Anyone, be it medical professionals, caregivers, healthcare facilities, patients, suppliers, vendors, employees, accountants or auditors can commit Medicare and Medicaid fraud. Fraud schemes range from solo ventures to widespread activities by an institution or group. Even organized groups can infiltrate the Medicare program. Here are some ways through which different entities and individuals commit Medicare and Medicaid fraud.

Providers commit Medicare fraud by:

• Knowingly submitting bills for services not provided or unnecessary services.
• Charging Medicare for a more expensive service than was provided (Upcoding).
• Billing Medicare for appointments that patients fail to keep.
• Submitting separate bills for services that are intended to be billed as one (Unbundling).
• Routinely waiving copays or routinely charging copays, even though your plan makes the services available with no copays.
• Billing non-covered services as covered service.

Suppliers and vendors commit fraud by:

• Soliciting, offering or receiving a bribe or kickback.
• Billing for different equipment than what the beneficiary received.
• Billing for home medical equipment after it is returned.

Insurance brokers commit Medicare fraud by

• Misleading, bribing or coercing a beneficiary to enroll into a plan just to make a commission.
• Enrolling a beneficiary into a Medicare Advantage Plan without their consent.

Companies and organizations commit fraud by:

• Offering a plan which is not approved by Medicare.
• Using false information to mislead beneficiaries.
• Billing Medicare for services that are different from those actually rendered.
• Offering or performing services that you do not need.
• Offering bribes or kickback to physicians for prescribing expensive drugs.
• Not following Medicare marketing rules.

Pharmacists commit fraud by:

• Skimping on the number of pills in the bottle to save money, or dispensing expired medications.

Beneficiaries can commit Medicare and Medicaid fraud by:

• Letting someone else use their Medicare card, providing their Medicare number in exchange of money, or selling their Medicare number to someone who bills Medicare for services not received.

Federal laws governing Medicare, Medicaid fraud and abuse:

Defrauding Medicare program expose individuals to potential civil, administrative and criminal activities, and may lead to fines, penalties and imprisonment.

False Claims Act (FCA), Stark Law, Anti-kickback Statute, Social Security Act, and the United States Criminal Code govern the Medicare fraud investigations, penalties and recoveries in the USA. These laws specify civil, administrative and criminal penalties and remedies the government may impose on entities or individuals that commit Medicare and Medicaid fraud. Violating these laws may result in Civil Monetary Penalties (CMPs), non-payment of claims, and exclusion from all federal healthcare programs. CMPs for violating FCA may include recovery of up to three times the amount of damages sustained by the government as a result of the false claims. Additionally, there could be penalties of up to $22,927 (in 2020) per false claim filed by the wrongdoers.

Funds wasted to Medicare fraud swindle the needy individuals

Medicare and Medicaid fraud are a multibillion-dollar drain on the US healthcare system that is already expensive to maintain. The fraud cost $60 billion annually to the hard-earned US taxpayers’ paychecks. The wasted funds lost to Medicare fraud represent resources that could have been used to support participants who really need assistance. Due to Medicare fraud, the needy individuals are swindled out of getting the services as the resources are diverted by unscrupulous parties looking to cash in at the expense of others.

How to report a Medicare fraud?

Reporting Medicare fraud is an important priority for the people and departments that oversee these critical healthcare programs supported by the US taxpayers. However, you need to follow the correct procedure to blow the whistle in Medicare fraud because if you blow it the wrong way, you may not get any award for your bravery and integrity. Brown LLC is the leading Medicare fraud whistleblower law firm with tens of millions of dollars in recoveries for its clients. The leading whistleblower law firm has some of the best lawyers who will help you in reporting Medicare fraud and blow the whistle in the right way.

When you file your Medicare whistleblower or Qui Tam case through Brown LLC’s whistleblower attorneys against your former or current employer or against an offending entity about which you have insider knowledge, they will guide you through each step of the whistleblowing procedure and file the case under seal on your behalf. That means, you will remain anonymous while the case is filed on your behalf by Brown LLC’s Whistleblower lawyers, and remain anonymous till the case has progressed to a certain stage.

You can get substantial case award for whistleblowing

Upon your reporting Medicare fraud, the government may or may not join in your claim. If the government joins investigations and are able to recover money from the wrongdoers, you may be awarded 15% to 25% of the total recovered amount. However, if the government doesn’t join investigations due to scarcity of resources, you can go solo to pursue your case through Brown LLC – one of the best whistleblower law firms headed by a former FBI Special Agent. In that case, you may get 15% to 30% of the total money revered by the government. Note that the government can recover up to three times the money for each false claim submitted to the Medicare and Medicaid programs. Whatever be the case, it is mandatory under FCA to use a Medicare fraud law firm to file your Qui Tam case.